The diagnosis and medical treatment of closed head injuries has changed radically over the past few decades.
If you are of a certain age, you may remember seeing an NFL player take a vicious blow to the head during a Monday Night game. While the announcers would gleefully observe, “Wow, he really got his bell rung!” the player would stagger off the field disoriented, get a whiff of smelling salts on the sideline from the medical team, and be back on the field the next play. Needless to say, that approach to a closed head injury horribly minimized the seriousness of the trauma, leading to lifelong problems for many players. The “You’re okay, get back in the game” attitude has been discarded by the medical community, and closed head injuries are now understood as having potentially life-changing consequences.
To begin with, what is a closed head injury? Closed head injury, concussion, and mild traumatic brain injury all mean the same thing - a trauma to the head that does not cause an overt skull fracture but which causes varying degrees of trauma to the brain and its supporting structures. Studies have shown that such injuries can occur even without lapsing into unconsciousness and without head contact with a hard surface. In an auto collision, a blow to the face from an air bag or contact between the back of the head and the padded headrest can cause brain trauma.
Proper diagnosis of closed head injury can be a challenge, and most emergency rooms perform but a cursory investigation after a car crash. MRI’s or CT Scans can confirm or rule out skull fractures, brain swelling, or hematoma, but they don’t answer whether a closed head injury has taken place.
The diagnosis of closed head injury typically involves a combination of careful patient history, focused physical examination, specific imaging tests, and neurological evaluations.
- Patient History: When the patient presents for a medical evaluation, the physician should ask about classic symptoms the patient may have noticed at home in the days after the car crash - headache, dizziness, forgetfulness, nausea/vomiting, sleeplessness, light sensitivity, speech disruption, changes in vision or mood - these are all classic markers that may support the diagnosis. Some of these symptoms can be subtle, with changes noticed more by family members than the patient themselves.
- Physical examination: The healthcare provider will examine the patient for any signs of head trauma, including any bumps, bruises, or lacerations. They will also check the patient's vital signs and perform a neurological exam to assess brain function, such as reflexes, eye movements, and coordination.
- Imaging tests: Imaging tests, such as a CT scan or MRI, can help identify any damage to the brain. A CT scan is often the first imaging test performed after a head injury, as it can quickly detect any bleeding or swelling in the brain. While MRI’s or CT Scans are helpful, they don’t fully answer whether a closed head injury has taken place. Some trauma to the brain’s nerve structures is microscopic and cannot be detected by typical studies.
- Neurological evaluation: A healthcare provider may use a neurological evaluation to assess brain function in more detail. This may include testing the patient's memory, language, and cognitive function.
If a closed head injury is diagnosed, one of the most common treatments now is rest, but not just any rest. In addition to directing the patient off work, it is now common practice to recommend a complete break with any activity that uses the brain. So even while off work, the patient is encouraged to not drive a car, use a computer, read books or scroll news stories on their phone and are instead encouraged to spend as much time in a quiet, darkened environment as they are able. Medications to address headaches may be prescribed. If there are disruptions to speech or memory, some specific therapies may also be prescribed. For confirmed head injuries, there is no quick fix, and the body’s slow “self-healing” process can mean lengthy symptoms and a significant impact on one’s livelihood.
It is important to seek medical attention if you experience any of these symptoms after a head injury. Early diagnosis and treatment can help prevent further damage to the brain and improve the patient's overall outcome.
At Sussman & Simcox, we have experience in representing clients with these types of injuries and can help guide you through the process of diagnosis and treatment. If you or a family member were recently involved in a traffic collision with a possible closed head injury, choose a firm with experience in this area. Call Sussman & Simcox for a free initial consultation. We take these injuries seriously, and you should too.